PHI 39/18 Private Health Insurance Legislation Changes

Page last updated: 29 June 2018

PHI 39/18 Private Health Insurance Legislation Changes (PDF 44 KB)

The Private Health Insurance (Benefit Requirements) Amendment Rules 2018 (No. 3) (the Benefit Requirements Amendment Rules) amend the Private Health Insurance (Benefit Requirements) Rules 2011 and were registered with the Federal Register of Legislation (FRL) and commenced on 1 July 2018.

Overnight and Same Day Accommodation Benefits at Private Hospitals and Public Hospitals

Increases to overnight accommodation benefits and same day accommodation benefits at private hospitals and public hospitals have been made to reflect the March 2017 to March 2018 Consumer Price Index (CPI) increase of 1.9%.

The Benefit Requirements Amendment Rules update the minimum benefit payable per night for patients in private hospitals in all States/Territories and shared ward accommodation at public hospitals in Victoria and Tasmania, providing that the patient is not classified as a nursing-home type patient. The following rates will apply:

Advanced surgical patient
- first 14 days $432
- over 14 days $301

Surgical patient or obstetric patient
- first 14 days $401
- over 14 days $301

Psychiatric patient
- first 42 days $401
- 43 – 65 days $347
- over 65 days $301

Rehabilitation patient
- first 49 days $401
- 50 – 65 days $347
- over 65 days $301

Other patients
- first 14 days $347
- over 14 days $301

An amendment has been made to the minimum benefit payable per night for patients in shared ward accommodation at public hospitals in the Australian Capital Territory (ACT), New South Wales (NSW), Northern Territory, Queensland, South Australia and Western Australia, providing that the patient is not classified as a nursing-home type patient. The new rates are as follows:

ACT $357
NSW $357
Northern Territory $357
Queensland $366
South Australia $357
Western Australia $357

New rates for minimum benefit for same-day accommodation in public hospitals and in private hospitals are implemented in each State and Territory and are as follows:
Public HospitalsBand 1Band 2Band 3Band 4
NSW$259$290$318$357
ACT$259$290$318$357
Northern Territory$259$297$343$357
Queensland$265$299$328$366
South Australia$259$297$327$357
Tasmania$252$300$346$401
Victoria$254$301$348$401
Western Australia$294$294$294$294
Band 1Band 2Band 3Band 4
Private Hospitals$224$282$343$401

Nursing-Home Type Patients


Increases were made to the minimum benefits for Nursing-Home Type patients (NHTP) in public hospitals in the ACT and South Australia to reflect the twice annual pension increase which occurred 20 March 2018. The following new rate will apply:
State/TerritoryMinimum benefit per night
Australian Capital Territory$125.00
South Australia$120.00
The existing rates for other states and territories remain in force and are as follows:
State/TerritoryMinimum benefit per night
New South Wales$124.50
Northern Territory$90.69
Queensland$125.00
South Australia$118.00
Tasmania$144.10
Victoria$134.00
Western Australia$138.10

Second Tier Default Benefits

The purpose of the amendments to Schedule 5 is to insert a reference to the new list of Second-tier eligible facilities compiled by the Second Tier Advisory Committee. Further information about this is available in PHI Circular 38/18.

Medicare Benefit Schedule (MBS) Item Changes

The Benefit Requirements Amendment Rules amend MBS items in Schedule 1 and 3 of the Principal Rules to add 13 new MBS items.

Item 1 - Schedule 1, Part 2 Type A procedures, Clause 4 Advanced Surgical Patient (3)
Item 1 amends Schedule 1, Part 2 Type A procedures, Clause 4 Advanced Surgical Patient, subclause 3 of the Principal Rules by inserting one MBS item (35585).

Item 2 - Schedule 1, Part 2 Type A procedures, Clause 6 Surgical patient (3)
Item 2 amends Schedule 1, Part 2 Type A procedures, Clause 6 Surgical patient, subclause 3 of the Principal Rules by inserting two MBS items (35581 and 35582).

Item 3 - Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 5 – Diagnostic Imaging Services, I5
Item 3 amends Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 5 – Diagnostic Imaging Services, subclause I5 of the Principal Rules by inserting four MBS items (63541, 63542, 63543 and 63544).

Item 4 - Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 6 – Pathology Services, P7
Item 4 amends Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 6 – Pathology Services, subclause P7of the Principal Rules by inserting six MBS items (73345, 73346, 73347, 73348, 73349 and 73350).

Details of the amendments are set out in the Benefit Requirements Amendment Rules, which are available on the Federal Register of Legislation website.

Changes to the Private Health Insurance (Complying Product) Rules 2015

The Private Health Insurance (Complying Product) (ACT Nursing Home Type Patient) Amendment Rules 2018 (Complying Product Amendment Rules) commence on 1 July 2018. These Rules amend the Private Health Insurance (Complying Product) Rules 2015. Details of the amendment are set out in the legislative instrument, which is available on the Federal Register of Legislation website.

These amendments update the patient contribution rates for Nursing-home type patients in the Australian Capital Territory to $60.05.
State/TerritoryContribution Rates
Australian Capital TerritoryFrom $58.80 to $60.05
    The existing rates for other states and territories remain in force and are as follows:
    State/TerritoryContribution Rates
    New South Wales$60.05
    Northern Territory$57.85
    Queensland $60.05
    South Australia$60.05
    Tasmania$60.05
    Victoria $60.05
    Western Australia$60.05
    Private hospitals nationally$60.05